Individual provider Active NPI

Elian Gonzalez

  • Primary Care Nurse Practitioner
  • Miami, FL
National Provider Identifier
1306622683
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
11027936 Issued in FL
Practice address
1479 NW 27TH Ave
Miami, FL 33125-2133
Phone
(305) 633-3776
NPI assigned
Sep 4, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 11027936 FL Primary

Addresses

Primary practice location

1479 NW 27TH Ave
Miami, FL 33125-2133

Mailing address

1576 SW 154TH CT
Miami, FL 33194-2648
Phone (786) 362-9724

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241016004924 FL Practitioner - Nurse Practitioner 3274065180 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11027936FLMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clinica Las Mercedes, LLC Current Accepting new patients
Clinica Las Mercedes, LLC CurrentSince Nov 1, 2024 Accepting new patients
Clinica Las Mercedes, LLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

9853 SW 40th St
Miami, FL 33165
Phone (305) 223-4685

1479 NW 27th Ave
Miami, FL 33125
Phone (305) 633-3776

6355 NW 36th St
Ste 1100
Virginia Gardens, FL 33166

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1306622683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1576 SW 154TH CT",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331942648",
            "telephone_number": "786-362-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1479 NW 27TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331252133",
            "telephone_number": "305-633-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "ELIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-04",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "11027936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.